Athetosis
Athetosis is a movement disorder marked by slow, involuntary writhing movements that you cannot control, affecting your hands, feet, arms, legs, and sometimes your face and tongue.
Table of contents
- What is athetosis?
- Symptoms and characteristics
- What causes athetosis?
- Brain areas affected
- Related movement disorders
- How is athetosis diagnosed?
- Treatment options
What is athetosis?
Athetosis is a condition marked by constant writhing movements that you cannot control[1]. These movements are slow, involuntary, and often described as “writhing” or “worm-like”[2]. The movements are continuous and typically affect the same regions of your body repeatedly[1].
Athetosis is not a disease itself but rather a symptom of another underlying condition[4]. The movements can be so persistent that they continue even when you are at rest, although they usually disappear during sleep[1]. What makes athetosis particularly challenging is that the movements often get worse when you try to control them[2].
Symptoms and characteristics
The main signs of athetosis include slow, involuntary, writhing muscle movements that affect various parts of your body[1]. These movements most commonly occur in your hands, arms, and feet, but your neck, face, tongue, and trunk can also be involved[1].
The movements you experience with athetosis are random and unpredictable[1]. Your fingers may flex and extend in an entirely irregular way, and your hands as a whole may also move involuntarily[4]. These movements become worse when you attempt controlled actions or try to improve your posture[1].
People with athetosis may also experience what is called muscle “overflow”[1]. This happens when you try to control one muscle or muscle group and experience uncontrolled movement in another muscle group. For example, when you attempt to talk, you may see increased muscle activity in your arm[1].
Other symptoms can include difficulty standing, problems with talking, and challenges maintaining a symmetrical and stable posture[1]. The movements cannot be stopped for more than a moment by willpower and are made worse by voluntary movements[4].
What causes athetosis?
In many cases, athetosis is caused by complications during birth[2]. Birth-related causes include asphyxia, which is when the baby’s brain does not receive enough oxygen[11]. This lack of oxygen can directly damage certain brain structures and lead to the development of athetosis[11].
Neonatal jaundice is another important cause[11]. When jaundice occurs in newborns, high levels of bilirubin, a yellow substance in the blood, can damage specific parts of the brain. Because a baby’s immune system has not fully developed, these toxins can travel through the infant’s body and cause brain damage[20].
Athetosis can also develop later in life due to stroke or trauma[11]. Various diseases can cause athetosis as well, including Huntington’s disease, a rare hereditary condition[18]. Wilson’s disease and other metabolic disorders are also associated with athetosis[18].
Certain medications can cause athetosis as a side effect[18]. These include some drugs used in the treatment of psychiatric disorders and Parkinson’s disease[18]. Drug toxicity can increase the levels of dopamine, a chemical messenger in the brain, which can lead to brain damage and cause athetosis[20].
Brain areas affected
Athetosis is usually caused by damage to the basal ganglia, which are structures found deep within the brain near its base[3]. The basal ganglia help coordinate muscle movement and control voluntary actions[3].
It is often caused by injury to these basal ganglia[3]. The condition results from malfunctioning of the basal ganglia of the cerebrum, the largest part of your brain[4]. Lesions, or areas of damage, in the brain are most often the direct cause of the symptoms, particularly to a structure called the corpus striatum[11].
- Basal ganglia
- Corpus striatum
- Cerebrum
- Hippocampus
- Motor thalamus
- Caudate nucleus
- Putamen
The lesions caused by lack of oxygen are most prominent on the caudate nucleus and the putamen, both parts of the basal ganglia[11]. Damage to these areas can also affect the concentrations of dopamine within the connections between brain cells, leading to increased dopamine activity[11].
Related movement disorders
Athetosis is closely related to other movement disorders, and it can sometimes occur together with them.
Chorea
Athetosis and chorea are very similar conditions[1]. In fact, they can occur together, and when they do, the combined condition is called choreoathetosis[1]. Athetosis, with its flowing and writhing movements, is sometimes called slow chorea[1].
Chorea is characterized by brief and irregular movements, dancelike jerking and rhythmic movements, sudden muscle contractions, and involuntary movements that begin and end abruptly and unpredictably[1]. Chorea primarily affects the face, mouth, trunk, and limbs[1].
Dystonia
Dystonia is also a movement disorder that involves involuntary and sustained muscle contractions[1]. This can result in twisting, repetitive movements. Like athetosis, dystonia can make maintaining a normal posture difficult[1].
Symptoms of dystonia include one or more repeated postures, persistent or intermittent muscle contractions, abnormal repetitive movements, asymmetrical posture, and potential involvement of the trunk, legs, neck, or arms[1]. Dystonia may involve one muscle group or several[1].
Cerebral palsy
Athetosis is commonly associated with cerebral palsy[18]. Athetoid cerebral palsy, also known as dyskinetic cerebral palsy, is a subtype of cerebral palsy where athetosis is the main symptom[5]. This is the second most common subtype of cerebral palsy, comprising around 12% to 14% of patients with the condition[5].
dyskinetic cerebral palsy, athetoid cerebral palsy, choreoathetosis, slow chorea
How is athetosis diagnosed?
To diagnose athetosis, your doctor will need to identify the underlying cause, since athetosis is a symptom rather than a disease itself[20]. The diagnostic process typically begins with a complete medical history[20].
Your doctor will perform a physical examination to observe your movements and assess your muscle tone, reflexes, and coordination. They will look for the characteristic slow, writhing movements and determine which parts of your body are affected.
Various diagnostic tests may be used to help identify the cause of athetosis. These can include imaging scans of the brain, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, to detect signs of brain damage[14].
Blood tests may be performed to check for metabolic disorders, infections, or other conditions that could be causing the symptoms[20]. If a hereditary condition is suspected, genetic testing may be recommended.
Treatment options
There is no cure for athetosis, but various treatments can help manage the symptoms and improve your quality of life[18]. Treatment approaches focus on reducing the severity of involuntary movements and improving your ability to perform daily activities.
Medications
Several types of medications may be used to help control athetoid movements[18]. These can include anti-epileptic drugs, muscle relaxants, and anti-dopamine drugs[18]. Antipsychotic medications may also be prescribed to help manage symptoms[1].
Botox injections can be used to weaken affected muscles and temporarily limit involuntary movements[18]. This treatment involves injecting botulinum toxin into specific muscles to reduce their activity[12].
Therapy approaches
Physical therapy and occupational therapy are important parts of treatment for athetosis[18]. These therapies can help improve your strength, coordination, and ability to perform daily activities.
Deep water jogging can be an effective intervention[22]. When immersed in water, you receive more information about where your body is in space, and the added resistance of the water works to improve strength and control[22].
Compression garments that provide deep pressure can help reduce the number and severity of athetoid movements[22]. These garments, which deliver constant and consistent therapeutic pressure, help to increase sensory feedback and provide musculoskeletal support[18].
Other treatment options
In some cases, surgical intervention may be considered[18]. However, surgical treatments for athetosis have historically been controversial and carry significant risks[13].
Treating the underlying cause of athetosis, when possible, may help improve symptoms[10]. For example, if athetosis is caused by a metabolic disorder, treating that disorder may reduce the severity of movements.
Living with athetosis can be challenging, and many people require support with day-to-day activities[18]. Support groups and counseling can help you and your family cope with the condition. Adults with athetosis who feel supported and accepted by peers are less likely to develop low self-esteem[18].
